Traumatic injury is a significant threat to our nation's children, having a higher mortality rate than all other causes of death combined. The American College of Surgeons Committee on Trauma states that injured children have special needs that may be optimally provided [for] in the environment of a children's hospital with a demonstrated commitment to trauma care. However, only a small proportion of acute care hospitals are characterized as trauma centers (TC), and even fewer are pediatric trauma centers (PTC). The large number of injured children, compared to the relative scarcity of PTCs, dictates that injured children will be cared for in a variety of hospital settings. Large TCs, including PTCs, are generally located in urban settings with a high population density. This creates a health disparity, leaving children in rural settings at a disadvantage and more vulnerable to poor outcomes from severe trauma. We cannot fully understand the magnitude and scope of pediatric trauma by state, region or nationally until we begin to analyze data collected from non-trauma centers as part of a statewide system. Because most injured children are treated in centers that lack trauma center designation and do not consistently, if at all, report trauma-related data, there is a significant gap in knowledge about this health disparity regarding the volume, treatments, and outcomes of injured children. The proposed project takes a critical step to address this current gap in research by analyzing data from the Ohio Trauma Registry, which captures data from approximately 87% of Ohio hospitals, as required by law, including 138 non-trauma centers (NTC). A total of 19,187 pediatric patients, over a 5-year period, will be analyzed to evaluate in-hospital mortality, length of stay, operations and complications by relevant covariates. Patients transferred from scene to an NTC, in the state of Ohio will be compared to those transferred directly from scene to a designated TC. This will provide valuable information about statewide pediatric injury rates, based on population density and where they are initially transported (via EMS or self- transport). Importantly, 58% of the traumatically injured pediatric patients in the Ohio trauma registry in the year 2010 were transferred from a hospital emergency department to another hospital. The outcomes of transferred patients may be confounded, as the patients may be more severely injured and have longer delays to appropriate specialized care. Therefore, we will analyze this group separately and include a calculated variable describing time since injury. Maps of injury burden, resources and access will be generated. We will estimate both distance traveled and time elapsed between injury and admission to the final point of care to characterize the relationship between rurality and treatment of pediatric trauma. At the end of the project, we expect to have a more thorough understanding of the magnitude of pediatric trauma and health disparities, especially in rural areas. Maps of injury burden, resources and access will be generated. The results of the analysis will reflect a statewide representation of where children are injured, where they first receive care and a characterization of patients who require inter-facility transport. This study wil provide a statewide perspective on the magnitude of the pediatric rural health disparity, and inform a future in-depth, prospective national study.